REGIONAL VARIATIONS IN MORTALITY-RATES IN ENGLAND AND WALES - AN ANALYSIS USING MULTILEVEL MODELING

Mortality rates in England and Wales display a persistent regional pat tern indicating generally poorer health in the North and West. Some of this is simply a reflection of regional differences in the extent of social deprivation which is known to exert a profound influence on hea lth. Part of the pattern may also be the result of regional difference s in urbanization which also affect mortality rates. However, there ma y be important regional differences over and above these compositional effects. This study attempts to establish the magnitude of such indep endent regional differences in mortality rates by using the techniques of multi-level modelling. Standardized mortality rates (SMRs) for mal es and females under 65 for 1989-91 in local authority districts are g rouped into categories using the ACORN classification scheme. The Town send Index is included as a measure of social deprivation. Using a cro ss-classified multi-level model, it is shown that region accounts for approximately four times more variation in SMRs than is explained by t he ACORN classification. Analysis of diagnostic residuals show a clear North-South divide in excess mortality when both regional and socio-e conomic classification of districts are modelled simultaneously, a pos sibility allowed for by the use of a multi-level model.